Doctor–Couple Communication During Assisted Reproductive Technology Visits

D. Leone; L. Borghi; S. Del Negro; C. Becattini; E. Chelo; M. Costa; L. De Lauretis; A.P. Ferraretti; G. Giuffrida; C. Livi; A. Luehwink; R. Palermo; A. Revelli; G. Tomasi; F. Tomei; C. Filippini; E. Vegni

Disclosures

Hum Reprod. 2018;33(5):877-886. 

In This Article

Results

Sample Characteristics

Out of 148 eligible ART consultations, a total of 92 couples agreed to participate. After seven consultations were excluded due to technical problems, 85 consultations were eligible for analysis. The response rate was 62.2%. No differences were found between patients who agreed and those who refused to participate in terms of sociodemographic characteristics (see Supplementary Table SI).

A total of 28 gynecologists and 160 patients participated. The majority of patients were couples (n = 75 couples, 88%). The demographic and clinical characteristics of the participants are shown in Table II.

Out of the 85 visits collected, 49 were first visits and 36 were check-ups. None of the check-up visits involved a couple who had been videotaped during the first meeting.

Communication Content

The average visit duration was 37 min (SD = 17.7). In terms of the communication content, physicians accounted for 64% and patients for 36% of all consultation statements. The mean verbal dominance was 1.9 (SD = 0.86, range: 0.72–5.74). Out of the consultations at which both male and female partners were present, females accounted for 67% of all patient talk.

Physicians were found to be mainly focused on providing information about medical conditions and treatment (μ = 223.5, SD = 134.2). However, over and beyond medical information, their communication content was very diversified, primarily involving socioemotional exchanges: emotional talk (μ = 51.4, SD = 38.5), positive talk (μ = 36.3, SD = 24.8), facilitation (μ = 49.9, SD = 45.9) and procedural talk (μ = 46.1, SD = 64.2) (Figure 1). On the other hand, communication content among couples was found to have a 2-fold focus on providing biomedical information (μ = 88.9, SD = 57.6) and on positive talk (μ = 82.9, SD = 60.0) (Figure 2).

Figure 1.

Frequencies of physician Roter Interaction Analysis System (RIAS) composite categories.

Figure 2.

Frequencies of patient Roter Interaction Analysis System (RIAS) composite categories.

The mean PCI was 0.51 (SD = 0.28; range 0.08–1.77). Patient centredness did not differ between first visits and check-up (t = 0.59, P = 0.56) (Figure 3), while it significantly differed by treatment advice (F = 6.30, P < 0.001) (Figure 4) and doctor's gender (t = −3.15, P = 0.002) (Figure 5). In particular, PCI was found to be significantly higher in those visits in which the treatment indication was for an heterologous fertilization (compared to all the other type of indications) and in the visits in which the doctor was a woman.

Figure 3.

Patient centeredness index by type of visit.

Figure 4.

Patient centeredness index by treatment advice.

Figure 5.

Patient centeredness index by doctor's gender.

Comparison Between Male and Female Talk

The paired t-tests showed that females reported a significantly greater number of total utterances than males, with a large effect size (descriptive statistics showed that the female partners contributed 67% of all patient talk, with a ratio of female/male All talk of 2:1). Moreover, female verbal exchanges were significantly higher in almost all the RIAS composite categories when compared to their male partners, with effect size ranging from small to moderate and moderate for some categories (Biomedical questions, Lifestyle/Psychosocial information, Facilitation/Activation, Emotional expression and procedural talk) and from moderate to large and large for others (Biomedical information and positive talk) (Table III).

As the t-tests showed female dominance in every RIAS category, Chi-squared tests were calculated using the observed frequencies of female and male All talk (i.e. 2:1) as expected frequencies. The results are shown in Table IV. With respect to the expected frequencies, females reported significantly more utterances in the following specific categories: Biomedical information, Positive talk and Procedural talk. Moreover, differences between female and male contribution to the visit according to the cause of infertility (female factor versus male factor versus other factors) were evaluated. No statistically significant differences were found (Supplementary Table SII).

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